The SA Health Department says the late payment of staff at National Health Insurance (NHI) pilot sites has been ‘resolved’ and that the problem ‘did not set the tone’ for the roll out of the programme.
South Africa is piloting the NHI, which will see citizens accessing health care based on their health needs, irrespective of their socio-economic status. The NHI – a health financing system that is designed to pool funds to provide access to quality, affordable health care – is part of government’s major health sector reforms and is being rolled out over a 14-year period.
Recent media reports said doctors and pharmacy assistants contracted to assist in the project had experienced delays in receiving their payments. However, Health Department spokesperson Popo Maja says that the issue of late payment had been resolved. Maja said the late payments were due to a change of payment administrators and an unanticipated problem in the administrative support for the project. Notwithstanding, Maja said these challenges had been resolved.
He said this would not affect the roll out of the NHI, as the doctors and pharmacists in question have received payments for more than 50 months without incident. The pilot project started in April 2012. Maja said those affected by the late payments were not employees but service providers.
The pilot, Maja said, is being conducted to get a sense of interest from private sector health practitioners, and to see how health practitioners and clinic staff would work together. The pilot is also an opportunity to test payment and administrative mechanisms, as the NHI fund would be a separate entity with its own administrative processes, Maja said.
City Press had reported earlier that the long-term viability of the NHI system was in doubt because its pilot project sites appear to have had financial problems failed to pay the salaries of its medical professionals,. Doctors and pharmacy assistants contracted to assist in the project have seen their debit orders bounce while they wait for salaries from the department of health’s appointed payroll administrator. The department appointed the Foundation for Professional Development (FPD) as a service provider to deal with administrative processes, including the payroll.
According to the report, the foundation’s payroll manager, Jackie Swanepoel told doctors and pharmacists in December that the FPD was unable to pay their salaries. “Due to unforeseen circumstances beyond our control, we will not be able to settle payments due on the 15th of December to Department of Health employees. “We are aware and understand the inconvenience caused by this, and are committed to resolving the matter with the Department of Health and the Treasury as soon as possible. We kindly request your understanding in this matter,” Swanepoel is quoted as saying.
The report says one doctor, who spoke on condition of anonymity, said the financial problems were not limited to December. “We had similar problems in September, October and November. The salaries are not paid on time and when we inquire, we are informed the department did not pay the service provider.
“We are still expected to wake up every morning and work as if everything is normal. Several doctors and pharmacy assistants have already quit their jobs and more will follow if the problems are not resolved,” he said.
The foundation’s chief operating officer, Henk Reeder, said he understood the concerns raised by the health practitioners but, “unfortunately, FPD is contracted by the health department to provide only a payroll administrative service and, as such, we are not in a position to comment on the health department’s structures and processes”.
The report says the pilot project, which started in April 2012, has 326 pharmacy assistants and 203 general practitioners (doctors) on the books. It will end in March, when government is expected to announce when the full NHI system will be launched.
Issues surrounding NHI funding were investigated by the Davis Tax Committee, which delivered its report on the financing of the NHI in October 2016. The government’s white paper on the NHI previously said it would require R256bn in annual funding at 2010 prices. The study estimated that, by 2025, a funding shortfall of R72bn would be expected at an assumed average growth rate of 3.5%. The study said that, at the real economic growth rate of just 2%, it would result in a shortfall of as much as R108bn by 2025.
Maja is quoted in the report as saying that the problem would not affect the introduction of the NHI as the doctors and pharmacists have received payments for more than 50 months without a problem. “This does not set the tone for what will happen under NHI. This is a pilot programme managed by the health department. It was mainly conducted to gauge interest from private health practitioners, to test models for cooperation between health practitioners and other clinic staff, and to test payment and administrative mechanisms.
“The NHI fund will be a separate entity with its own administrative processes.”
Asked about the resignation of some medical professionals, Maja said it was not true that professionals were leaving the pilot project because of late payments. “Whenever people have an issue with the public sector, they drag in the NHI. The issue of late payment has been resolved.”